Peripheral Vascular Diseases

Question 1

What is a perforator vein?

Answer 1

they perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain

Superficial –> perforator –> deep veins

Question 2

What is the hydrostatic indifferent point?

Answer 2

The hydrostatic indifference point (HIP; where venous pressure is unaffected by posture) is located at the level of the diaphragm.

Question 3

What percentage of acute thrombosis are due to cancer?

Answer 3

40%

Question 4

What is Virchow’s Triad?

Answer 4

Virchow’s triad or the triad of Virchow describes the three broad categories of factors that are thought to contribute to thrombosis:

1. Hypercoagulability
2. Hemodynamic changes (stasis, turbulence)
3. Endothelial injury/dysfunction.

Question 5

What may cause stasis (ie. blood is not flowing or circulating as optimally as it could to all parts of the body)?

Answer 5

Venous stasis, mitral stenosis, prolonged immobility (such as car or plane ride or bed bound), varicose veins

Question 6

What may cause hypercoagulability?

Answer 6

Antithrombin III, protein C and S, Leiden V Factor
Nephrotic syndrome, Trauma and burns, obesity, race, age
Disseminated cancer, hormonal contraceptives, smoking

Question 7

What is Phlegmasia Cerulea Dolens?

Answer 7

acute DVT characterized by marked swelling of the extremities with pain and cyanosis, which in turn may lead to arterial ischemia and ultimately cause gangrene with high amputation and mortality rates.

Question 8

What do treatments target for acute thrombosis?

Answer 8

prevention centers on anticoagulation and preventing platelet adherence to the endothelium

Question 9

What are some Pharmaco-mechanical thrombolysis?

Answer 9

Power pulse; isolated segment thrombolysis

Question 10

What can duplex scanning identify?

Answer 10

Duplex scanning will identify areas of obstruction and can look at reflux that would explain incompetence

Question 11

What is Superficial Phlebitis?

Answer 11

The non-dangerous “blood clot” to the surperficial veins only (not the deep).

Leg gets red, hot, and painful in a localized area.
An inflammatory process

Question 12

What is Chronic Venous Insufficiency?

Answer 12

Deep venous valves are not working

Question 13

What is Post Thrombotic Syndrome?

Answer 13

CVI that develops after DVT

Question 14

What may cause varicose veins?

Answer 14

• incompetent perforators

- incompetent superficial valves

Question 15

What is the Trendelenberg Test?

Answer 15

The Trendelenburg Test or Brodie-Trendelenburg test is a test which can be carried out as part of a physical examination to determine the competency of the valves in the superficial and deep veins of the legs in patients with varicose veins.

What is the positive finding?

Question 16

What may contribute to chronic swelling?

Answer 16

• Arterial Problems:
  Rest pain, post op (reperfusion injury), aneurysms
• Venous Problems:
  Chronic occlusion
  Chronic Venous Insufficiency
• Lymphatic Problems:
  Lymphedema- Primary and Secondary
• Musculoskeletal: Baker’s Cyst, tumors
• Abnormal Growth: Ateriovenous malformations, tumors,

Question 17

How to assess swelling?

Answer 17

• pitting vs. non-pitting (does socks cut in or leave a mark)
• measure circumference

Question 18

T or F: the swelling caused by lymphedema is pitting

Answer 18

F: non-pitting

Question 19

What are some functions of the lymphatic system?

Answer 19

• Removes excess interstitial fluid and protein from the tissues
• Removes fats and fatty acids from the gut
• Transports white blood cells and antibacterial defense system back and forth from tissues, lymph nodes and marrow.

Question 20

Is swelling hard to treat resulting from lymphedema?

Answer 20

Yes, and does not disappear easily

Question 21

What is primary lymphedema?

Answer 21

Congenital lack of sufficient number of lymphatics that manifests itself at different ages

Question 22

True or False: 1o lymphedema occurs in men more and in the right leg

Answer 22

False: women; left leg

Question 23

What are the different classes of 1o lymphedema?

Answer 23

Lymphedema cogenta (baby, child)
Lymphedema praecox (early 20’s)
Lymphedema tarda (elderly)

Question 24

What is the most common cause of 2o lymphedema?

Answer 24

due to an infestation of the lymph nodes by the parasite Filaria bancrofti

(cancer surgery and/or radiation more so common in NA)

Question 25

True or False: in CVI there elevated ambulatory venous pressure (ie. hypertension)?

Answer 25

True

Question 26

For venous issues what would you look dermatologically?

Answer 26

Irregular, often deep ulcer
Draining if leg edematous
Pigmentation
Subcutaneous stiffness (lipodermatosclerosis)
Old or new ulceration
Edema: pitting or non pitting
Varicosities, spider veins

Question 27

True of False: majority of those with CVI had a previous DVT

Answer 27

False

Question 28

What happens in persistent calf pump failure?

Answer 28

Dilation and elongation of venules and capillaries

–> The main factor contributing to the development and progression of varicose veins is sustained venous hypertension that increases the diameter of the superficial veins resulting in further valve incompetence.

Contraction of calf muscle opens vein valves and promotes

Question 29

What is usual pathogenesis of CVI?

Answer 29

1. Calf Pump Failure
2. Capillary and Venular Elongation and Dilatation
3. Increased production of tissue fluid with raised fibrinogen concentration and raised inhibitors of fibrinolysis
4. Tissue Anoxia and Malnutrition
5. Lipodermatosclerosis
6. 5 Trauma
7. Ulcer

Question 30

What risk is increased with elevated ambulatory venous pressures?

Answer 30

ulcers

Question 31

What are the benefits of graduated compression therapy?

Answer 31

• increased venous return
• increased removal of fibrin
• decreased edema
• decreased distention of superficial veins

Question 32

What is the primary treatment of CVI?

Answer 32

compression

Question 33

What is sclerotherapy?

Answer 33

Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink.

Question 34

What are some treatment options for saphenofemoral insufficiency?

Answer 34

• ligation (tieing)
• stripping (removing)
• endovenous ablation (damaging with heat)